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Thinking PHAST for stroke assessment

Regardless of the stroke score or scale that you utilize, what’s most important is having a strong foundation to rely on for stroke assessment and care

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Times are changing, and so is the way that we assess for a stroke.


CPSS, CPSSS, FAST-ED, BE-FAST, and many more – stroke assessment has certainly evolved over the past decade, even within the past few year, so it’s often seen as a moving target within the EMS industry (and hospital environment, too).

Regardless of the score or scale that your EMS agency utilizes, what always holds reliable and true is your foundational knowledge, especially when it comes to stroke.

What does the brain do, and what might its deficits be if it’s not able to function properly? This is the foundation behind programs like the Prehospital Advanced Stroke Training (PHAST) course, developed by Centura Health in Colorado.

Stroke assessment and care isn’t just an in-hospital endeavor; it involves every EMS provider and agency. Facial droop, arm drift and slurred speech are just the beginning findings of an acute stroke (either ischemic or hemorrhagic in nature).

What else should we look for, though? How about focusing on a primary versus secondary assessment; a concept that we’re already used to in EMS? This is what the PHAST course is all about. It’s not designed to take over your current assessment tool, but designed to supplement and boost knowledge regarding stroke assessment and patient care – as an EMS provider.

The program was developed in 2016 by EMS educators and stroke coordinators/managers within the greater Denver and Colorado Springs service areas of the Centura Health system. This six-hour course provides a comprehensive breakdown of the background, anatomy and physiology, assessment and continuum of care related to prehospital strokes.

Relying solely on “face, arms and speech” might get an EMS provider to recognize the great majority of strokes, but what about the additional cortical signs of a large vessel occlusion? Or, differentiating between an occipital stroke versus a brainstem stroke (with each presenting differently, and possibly without any face, arms or speech deficits)? What about stroke mimics – different forms of palsy, migraines, or even hypoglycemia?

A foundation for stroke assessment and care

Having a strong foundation and base knowledge regarding stroke assessment and care is something that can either be incorporated into your initial education program, or as a part of your own continued education. As one of the leading causes of both death and disability in our nation, it’s imperative that EMS clinicians have a strong understanding behind this deadly, and often costly emergency.

Throughout the duration of the PHAST course, participants review case studies of actual patients, break-down patient assessment into an inherently understood context and even get a sneak-peak at what some of the imaging looks like for different stroke-injured patients. Combining this with education related to anatomy and physiology, patient care within the hospital setting (including medication administration and mechanical thrombectomy), and the patient’s journey to recovery, the PHAST course offers comprehensive education to meet what our true needs are within our industry.

Times are changing, and so is the way that we assess for a stroke. Regardless of the score or scale that your agency utilizes, if providers have a strong understanding behind all of the symptoms (deficits) associated with a stroke, then adapting any assessment tool toward their knowledge base will simply come much more easily. Taking a comprehensive stroke training course, like PHAST, will get them on the right track to becoming a comprehensive stroke assessment clinician (something that we should all strive to be).

Tim is the founder and CEO of Emergency Medical Solutions, LLC, an EMS training and consulting company that he developed in 2010. He has nearly two decades of experience in the emergency services industry, having worked as a career firefighter, paramedic and critical care paramedic in a variety of urban, suburban, rural and in-hospital environments. His background includes nearly a decade of company officer and chief officer level experience, in addition to training content delivery and program development spanning his entire career. He is experienced in EMS operations, community paramedicine, quality assurance, data management, training, special operations and administration disciplines, and holds credentials as both a supervising and managing paramedic officer.

Tim also has active experience as a columnist and content developer with over 200 published works and over 100 hours of education content available online, and is a social media influencer on LinkedIn within the EMS industry. Connect with him on LinkedIn or at